Healthcare Provider Details

I. General information

NPI: 1942073242
Provider Name (Legal Business Name): AFFINITY INTEGRAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 E MILWAUKEE ST STE 1135
JEFFERSON WI
53549-1636
US

IV. Provider business mailing address

144 E AUER AVE
MILWAUKEE WI
53212-2069
US

V. Phone/Fax

Practice location:
  • Phone: 414-530-2038
  • Fax:
Mailing address:
  • Phone: 414-530-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KANITHA BURKS
Title or Position: CEO
Credential:
Phone: 414-530-2038